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by E.J. Mundell

Experts Predict 'Catastrophic' Ebola Epidemic in West Africa if Aid Delayed

Yale team foresees 90,000 deaths in one Liberian county alone by Dec. 15
THURSDAY, Oct. 23, 2014 (HealthDay News) -- A large influx of international aid is needed, and soon, if West Africa is to avoid tens of thousands of deaths from the widening Ebola crisis, a team of Yale University researchers predict.
Using a specially designed mathematical model, the researchers looked at the possible future of the outbreak in just one densely populated county of hard-hit Liberia -- Montserrado County, home to the capital city of Monrovia.
The researchers said that if international aid isn't delivered to Liberia in sufficient time and quantity, by Dec. 15 Montserrado County will have more than 170,000 cases of Ebola -- 12 percent of its population -- and more than 90,000 deaths.
However, if the international community ramps up efforts by Oct. 31, almost 98,000 of those cases could be avoided.
"Our predictions highlight the rapidly closing window of opportunity for controlling the outbreak and averting a catastrophic toll of new Ebola cases and deaths in the coming months," study senior author Alison Galvani, professor of epidemiology at the Yale School of Public Health, said in a university news release.
"Although we might still be within the midst of what will ultimately be viewed as the early phase of the current outbreak, the possibility of averting calamitous repercussions from an initially delayed and insufficient response is quickly eroding," she added.
What's needed, according to the Yale team, are better diagnosis, treatment and prevention efforts on the ground in Liberia and in the two other countries affected by Ebola, Guinea and Sierra Leone. Essential elements include more Ebola treatment center beds, a fivefold increase in the rapidity at which new Ebola cases are identified, and the distribution of protective kits to households containing anyone already infected to cut the rate of Ebola's spread, the researchers said.
Even if international interventions were to be delayed until Nov. 15, about 54,000 new cases in Montserrado County might still be averted, the researchers said.
According to the latest estimates from the World Health Organization, about 10,000 cases of Ebola have so far been reported in the three affected countries, and more than 4,900 people have died.
Time is of the essence, the researchers said, to prevent the outbreak from exploding into something much less containable.
"The current global health strategy is woefully inadequate to stop the current volatile Ebola epidemic," study co-author Dr. Frederick Altice, professor of internal medicine and public health at Yale, said in the news release. "At a minimum, capable logisticians are needed to construct a sufficient number of Ebola treatment units in order to avoid the unnecessary deaths of tens, if not hundreds, of thousands of people."
The study, funded by the U.S. National Institutes of Health, was published online Oct. 23 in The Lancet Infectious Diseases.
More information
For the latest on the West African Ebola outbreak, head to the World Health Organization (http://www.who.int/csr/disease/ebola/en/ ).
SOURCE: The Lancet Infectious Diseases, news release, Oct. 23, 2014
by E.J. Mundell

Few U.S. Hospitals Ready to Handle Ebola, Survey Finds

Many don't have enough staff, training or equipment to control often deadly virus, experts say
FRIDAY, Oct. 24, 2014 (HealthDay News) -- Only about 6 percent of American hospitals have infection control procedures in place to effectively and safely handle Ebola patients, a new survey reveals.
Of the 1,039 acute care hospitals that responded to the survey, about 6 percent said they were "well-prepared," and about 5 percent said they were "not prepared," according to the Association for Professionals in Infection Control and Epidemiology (APIC).
"The results of the poll paint a disturbing picture, and point to an urgent need to bolster infection prevention resources in health care facilities," Katrina Crist, CEO of APIC, said during a noon press conference.
"The recent Ebola outbreak and the specter of other serious infectious diseases and antibiotic-resistant superbugs are another example of why infection prevention programs are critical to our nation's health care facilities," she said.
Crist said that not enough is being done to protect patients and health care workers.
According to the survey, the majority of hospitals (40 percent) said they were "somewhat prepared."
Hospitals surveyed ranged in size from fewer than 100 beds to more than 400.
The survey also found that only 51 percent of the hospitals had a full-time infection control expert on staff. These specialists are trained in identifying the source of infections and in stopping their spread in the hospital.
Of hospitals that said they had no such specialist or only one on staff, 4 percent claimed to be "well-prepared" to handle Ebola patients, the survey found.
Among hospitals with 11 or more infection specialists, 31 percent said they were prepared to deal with Ebola patients.
Speaking at the press briefing, APIC President Jennie Mayfield said, "This survey confirms our belief that many hospitals do not have enough staff dedicated to infection prevention and control."
APIC wants hospitals to beef up their procedures to handle Ebola patients. This includes staffing to ensure that properly trained infection control experts are present. In addition, the group is calling for rigorous training to ensure guidelines are followed at all times and that proper equipment is available.
Linda Greene, a member of APIC's regulatory review panel, said, "The current crisis really sheds light on how critically important properly resourced infection prevention programs are."
David Sanders, an associate professor of biological sciences at Purdue University who has been working on Ebola for a decade, said earlier that most hospitals are not prepared -- and don't need to be prepared -- to deal with the specialized isolation procedures that Ebola patients require.
Instead, he advocates that Ebola patients who are seen at hospitals not fully equipped and trained to deal with the virus should be immediately transferred to hospitals that are prepared.
"I do not think that most places have the training. They may have the infection-control equipment, but they don't have the training to deal with this type of infectious disease," he said.
Greene disagreed. Every hospital in the United States needs to be able to identify and isolate Ebola patients, she said.
"From there, it might be more judicious to send those patients to regional centers," she said. "But don't forget that an Ebola patient can walk into any emergency department, and therefore we must be prepared to do an initial assessment and treatment until transfer arrangements can be made."
More information
Visit the World Health Organization (http://www.who.int/mediacentre/factsheets/fs103/en/ ) for more on Ebola.
SOURCES: David Sanders, Ph.D., associate professor, biological sciences, Purdue University, West Lafayette, Ind.; Oct. 24, 2014, news conference with: Katrina Crist, CEO, Association for Professionals in Infection Control and Epidemiology (APIC); Jennie Mayfield, B.S.N., president, APIC; Linda Greene, R.N., member, regulatory review panel, APIC
by E.J. Mundell

New York City Ebola Patient in Stable Condition

Three contacts of Dr. Craig Spencer are in isolation; NYC mayor is urging calm
FRIDAY, Oct. 24, 2014 (HealthDay News) -- A New York City doctor who recently returned from West Africa infected with Ebola is in stable condition at Bellevue Hospital, media reports say.
Dr. Craig Spencer had been working with the medical aid agency Doctors Without Borders, helping to treat Ebola patients in Guinea, one of three West African countries hit hard by the disease.
According to The New York Times, Spencer, 33, had returned to New York City from Guinea on Oct. 14, and by 11 a.m. on Thursday morning he had developed a 100.3-degree fever. He immediately alerted Doctors Without Borders. Emergency medical workers in full personal protective gear transported him from his Manhattan apartment to Bellevue Hospital, where he has been since 1 p.m.
Three people he was in contact with in recent days, including two friends and Spencer's fiancee, have been placed in isolation, the Times reported.
On Wednesday, Spencer traveled on two subway lines from Manhattan into the Williamsburg section of Brooklyn, visited a bowling alley there and then took a taxi back to Manhattan.
According to the Times, the taxi driver had no direct contact with Spencer and is not considered to be at risk.
Speaking Thursday night at a press conference at Bellevue, Mayor Bill de Blasio stressed that "being on the same subway car or living near a person with Ebola does not in itself put someone at risk."
Out of an abundance of caution, however, the Brooklyn bowling alley has been closed temporarily while health workers visit it, and Spencer's home has been sealed off, the Times said.
According to the Times, Spencer is a fellow of international emergency medicine at NewYork-Presbyterian Hospital/Columbia University Medical Center, and an instructor in clinical medicine at Columbia University.
There was also some good news on the Ebola front. Both of the two nurses who fell ill with Ebola at a Dallas hospital have now been declared free of the virus. Nina Pham, 26, left the U.S. National Institutes of Health Clinical Center in Bethesda, Md., Friday and met with President Barack Obama at the White House before returning home.
And Amber Vinson, 29, has been declared Ebola-free after being cared for at Emory University Hospital in Atlanta. She will also return home soon, according to media reports.
Both nurses contracted Ebola after caring for Thomas Eric Duncan, a Liberian national who was the first case of Ebola diagnosed in the United States. Duncan died of the disease at Texas Health Presbyterian Hospital on Oct. 8.
The Ebola outbreak in West Africa has so far killed nearly 4,900 people out of nearly 10,000 reported cases, according to the World Health Organization.
More information
For more on Ebola, visit the World Health Organization (http://www.who.int/csr/disease/ebola/en/ ).
SOURCES: Oct. 23/24, 2014, The New York Times
by E.J. Mundell

Cadavers Beat Computers as Med School Teaching Tool, Study Finds

Researchers say future doctors and nurses learn more from the human body
FRIDAY, Oct. 24, 2014 (HealthDay News) -- Cadavers are better than a computer simulation of the human body for teaching anatomy to college students, a new study says.
The findings suggest that cadavers should continue to be used in undergraduate human anatomy courses for future doctors, nurses and other health and medical professionals, according to the researchers.
Their study included almost 240 students in a semester-long undergraduate anatomy course. One group of students learned on a cadaver and were tested on a cadaver. Other students learned on a computer simulation of the human body and were tested on a cadaver, according to the researchers.
The students were tested on being able to identify the parts of the body and to explain how they worked. On average, the students who learned on a cadaver scored 16 percent higher on identifying body parts and 11 percent higher on explaining what the body parts do, compared with those who learned on the computer simulation, the study found.
The difference in average scores was the difference between one grade, study co-author Cary Roseth, an associate professor of educational psychology at Michigan State University, said in a university news release.
The study appears in the September/October issue of the journal Anatomical Sciences Education.
"Our findings indicate that educational technology can enhance anatomy instruction but is unlikely to fully replace cadavers," Roseth said.
Most anatomy courses in the United States still rely on cadavers. But many also use computers to supplement the instruction, according to the researchers. However, there is ongoing debate over whether cadavers are needed at all, and some medical schools in Australia and the U.K. have stopped using cadavers to teach anatomy, according to the study authors.
More information
The U.S. National Library of Medicine has more about anatomy (http://www.nlm.nih.gov/medlineplus/anatomy.html ).
SOURCE: Michigan State University, news release, Oct. 16, 2014
by E.J. Mundell

Brief Interruption of Blood Supply to Limb Might Aid Heart Surgery: Study

Technique can trigger body's defense system to protect the heart, experts say
FRIDAY, Oct. 24, 2014 (HealthDay News) -- Interrupting blood supply to an arm or a leg before heart surgery may help reduce the risks associated with the surgery, according to a new study.
"During heart surgery we have to stop the blood supply to the heart to be able to operate on it. After some time without fresh blood, the heart will reduce its ability to produce energy because it doesn't get oxygen. When we shut off the blood flow to another large muscle, such as an arm or a leg, the body prepares for an upcoming challenge by mobilizing its defense system," said the study's first author, Dr. Katrine Hordnes Slagsvold, a doctoral candidate from the K.G. Jebsen Center for Exercise in Medicine Cardiac Exercise Research Group at the Norwegian University of Science and Technology in Trondheim, Norway, in a university news release.
The technique used in the study is called remote ischemic preconditioning (RIPC).
For the study, the researchers examined how RIPC affected the left chamber of the heart before surgery. Specifically, they examined the heart tissue of 60 patients who underwent coronary bypass surgery. The patients were selected at random to either undergo RIPC or not have this procedure performed before surgery, according to the study.
The patients treated with RIPC wore an inflatable blood pressure cuff that interrupted blood supply to their arm three different times prior to surgery. Each interval lasted for five minutes, according to the researchers.
"The heart muscle of the patients who had restricted blood flow to their arm before surgery was able to maintain the same level of energy production during the whole operation, while heart muscle from the other patients' hearts was not. This may be important because heart tissue is dependent on energy to survive, as well as to repair injuries the cells may have endured during surgery," Slagsvold explained.
RIPC activated a protein called Akt, the study revealed. The researchers suggested this may be a key factor in how the pre-surgery technique helps protect the heart.
The researchers report their findings in the Oct. 24 International Journal of Cardiology.
More information
The U.S. National Heart, Lung and Blood Institute provides more information on the risks associated with heart surgery (http://www.nhlbi.nih.gov/health/health-topics/topics/hs/risks.html ).
SOURCE: Norwegian University of Science and Technology, news release, Oct. 24, 2014
by E.J. Mundell

Childhood Peanut Allergy May Be Linked to Skin Gene Mutation

Study bolsters the dual-allergen-exposure theory, expert says
FRIDAY, Oct. 24, 2014 (HealthDay News) -- Infants with a specific skin gene mutation who are exposed to peanut protein in household dust may be more likely to develop a peanut allergy, according to a new study.
Peanut allergy and other food allergies have been linked to severe eczema, a skin disorder, in early infancy, the U.K. researchers said.
In conducting the study, researchers at King's College London and colleagues examined the amount of peanut protein to which 577 babies were exposed during their first year of life. This was done by measuring the amount of peanut protein in the dust collected by vacuum from the living room sofa in their home. The children were tested for peanut allergy years later when they were 8 and 11 years old. Their DNA was also checked for a specific skin barrier defect, known as an FLG mutation.
Previous studies identified a specific gene that codes for the skin barrier protein, filaggrin. Mutations to this gene, known as the FLG gene, lead to a skin barrier impairment, which is thought to make the body more vulnerable to an allergic reaction.
The study, published this month in the Journal of Allergy and Clinical Immunology, found that one in five children with peanut allergy had an FLG mutation.
The researchers found that a threefold increase in exposure to peanut protein in dust in the first 12 months of life was associated with a threefold increase in risk for a later peanut allergy. They said, however, exposure to peanut protein in household dust had no effect on children who did not have a skin barrier defect from an FLG mutation.
"Our findings provide evidence that peanut allergy may develop via the skin in children with mutations in the gene that codes for filaggrin which damage the function of this important skin protein," said the study's first author, Dr. Helen Brough, from the department of pediatric allergy at King's College London. "These findings are also an example of how an individual's response to their environment can be modified by their genes," Brough said in a university news release.
"Our study raises the possibility of being able to identify a group of children with FLG mutations through genetic testing in the future, and altering their environmental exposure to peanut early in life to reduce the risk of developing peanut allergy," she added.
The study offers further evidence for the dual-allergen-exposure theory, said the study's senior author, Gideon Lack, also from the King's College London pediatric allergy department. This theory "suggests food allergies develop through exposure to allergens via the skin, likely through a disrupted skin barrier, [and that] consumption of these food proteins early in life builds up tolerance in the body," he said in the news release.
"Previous guidelines recommending that mothers should avoid peanuts during pregnancy and breastfeeding have now been withdrawn. Ongoing studies at King's aim to find if exposure to solids in early infancy might actually help to prevent allergies," Lack said. "It may be that the timing and balance of skin and oral exposure to a particular food early in life determines whether a child develops an allergy or tolerance to that food."
About 2 percent of U.S. children are allergic to peanuts, according to the news release.
More information
The American College of Allergy, Asthma and Immunology has more about peanut allergy (http://www.acaai.org/allergist/allergies/Types/food-allergies/types/Pages/peanut-allergy.aspx ).
SOURCE: King's College London, news release, Oct. 21, 2014
by E.J. Mundell

Could Air Pollutants Raise a Child's Autism Risk?

Chromium, styrene implicated in preliminary study
FRIDAY, Oct. 24, 2014 (HealthDay News) -- Children exposed to two air toxins -- chromium and styrene -- while in the womb and during the first two years of life may have increased odds of developing autism, according to a new study.
Prenatal and early exposure to the highest amounts of chromium, a heavy metal, increased the risk for autism by 65 percent, said researchers from the University of Pittsburgh Graduate School of Public Health.
Styrene, found in car exhaust and industrial emissions, doubled the risk for the neurodevelopmental disorder, the investigators found.
Autism spectrum disorders -- a range of conditions involving social deficits and communication difficulties -- affect one of every 68 children in the United States, according to the U.S. Centers for Disease Control and Prevention.
"These findings are preliminary," said lead researcher Evelyn Talbott, a professor of epidemiology. She also cautioned that the study results show an association between exposure to these airborne chemicals and autism, not proof that they actually cause autism.
"We don't know what causes autism," Talbott said. "We have little information on risk factors. This is just one more piece of the puzzle."
Styrene and chromium might trigger a person's genetic predisposition to autism, Talbott said.
"More and more, people are believing in gene/environment interactions," she said. "We do know that about 10 percent of autism spectrum disorders run in families."
Another autism expert said this link needs to be pursued.
"This study may take us one step closer to getting out of the guessing game. It brings us back to considering chemicals," said Brandon Korman, chief of neuropsychology at Miami Children's Hospital Brain Institute in Florida.
The unanswered question, Korman said, is what causes one child to develop autism when another child does not, even though they are exposed to the same pollution.
The findings of the study were presented Wednesday at the American Association for Aerosol Research annual meeting in Orlando, Fla.
For the study, Talbott's group interviewed 217 families of children with autism spectrum disorder. The researchers compared them with two sets of families who had children without autism spectrum disorder born during the same time period and within the same six counties in southwestern Pennsylvania.
For each family, the team used the U.S. National Air Toxics Assessment for 2005 to estimate exposure to 30 pollutants known to affect the brain, glands and hormones.
Of all the chemicals in the environment, styrene, chromium and, to a lesser extent, cyanide stood out as most associated with autism spectrum disorder, the study concluded.
Styrene is used in the manufacturing of plastics and paint, the authors said. Chromium gets into the air through industrial operations, power plants and the hardening of steel. Cyanide can be found in industrial emissions and car exhaust.
Whether these chemicals are responsible for a particular type of autism is something Talbott would like to investigate. Also of interest, she said, is whether greater exposure increases the odds of developing the condition.
The data and conclusions of research presented at meetings are typically considered preliminary until published in a peer-reviewed medical journal.
More information
For more about autism, visit the U.S. National Institute of Neurological Disorders and Stroke (http://www.ninds.nih.gov/disorders/autism/detail_autism.htm ).
SOURCES: Evelyn Talbott, Dr.P.H., professor of epidemiology, University of Pittsburgh Graduate School of Public Health; Brandon Korman, Psy.D., chief, neuropsychology, Miami Children's Hospital Brain Institute; Oct. 22, 2014, presentation, American Association for Aerosol Research annual meeting, Orlando, Fla.
by E.J. Mundell

Dark Days Here for Folks With Seasonal Depression

Expert offers tips to compensate for reduced light exposure
FRIDAY, Oct. 24, 2014 (HealthDay News) -- October's shorter, darker days can trigger a type of depression, known as seasonal affective disorder, according to an expert.
People affected by seasonal affective disorder, also called SAD, may feel overly tired, lack motivation and even have trouble getting out of bed. In extreme cases, SAD can lead to suicide, said Dr. Angelos Halaris, a professor in the department of psychiatry and behavioral neurosciences at Loyola University Chicago Stitch School of Medicine.
"Seasonal affective disorder should not be taken lightly," Halaris said in a hospital news release.
Seasonal affective disorder affects up to 5 percent of the population, Halaris said. It's linked to a reduction in light exposure from shorter days and gray skies, which is thought to cause a chemical imbalance in the brain.
SAD season starts in October and lasts until the middle of April. Until then, there are ways to reduce your risk for the condition, advised Halaris. He said the following strategies might help:
Get outside. Spend at least 30 minutes a day outside. Avoid wearing sunglasses during this period of time. If weather permits, expose the skin on your arms to the sun. Let light inside. Keep your home well-lit. Open curtain and blinds to allow sunlight in. You can also consider buying a high-intensity light box specially designed for SAD therapy. Sit near the box for 30 to 45 minutes in the morning and at night. Be sure to talk to your doctor before attempting this type of light therapy on your own, Halaris cautioned. Exercise. Physical activity releases endorphins and other brain chemicals that help you feel better and gain more energy, Halaris explained. Exercising for 30 minutes daily can help. Consider medication. When all else fails, there are medications that can help ease the troubling effects of SAD. Halaris recommends visiting a mental health professional if extra sun exposure, indoor lights and exercise are not effective in treating your symptoms.
More information
The National Alliance on Mental Illness provides more information on seasonal affective disorder (http://www.nami.org/Template.cfm?Section=By_Illness&Template=/ContentManagement/ContentDisplay.cfm&ContentID=23051 ).
SOURCE: Loyola University Health System, news release, Oct. 20, 2014
by E.J. Mundell

Knowing Genetic Risk for Cancer May Not Change Behavior

Study found those who knew they had greater chance of getting colon cancer no more likely to be screened
FRIDAY, Oct. 24, 2014 (HealthDay News) -- As more genetic tests are developed that spot increased risks for certain cancers, one might think that high-risk people would be more proactive about getting screened.
But a new study suggests that, at least with colon cancer, knowledge does not change behavior: People who found out their genes doubled their risk of colon cancer were no more likely than people with average risk to get screened.
"It didn't make any difference, not at all," said study author Dr. David Weinberg, chairman of medicine at Fox Chase Cancer Center in Philadelphia.
Weinberg cautioned against using the findings to come to conclusions about the impacts of genetic tests for other cancers. Still, he said, the "modest amount of available data" suggests that genetic tests like the colon cancer one -- which don't confirm a huge increased risk of disease -- don't alter health habits.
The researchers were surprised by the results. "Our hypothesis was that this would be effective," Weinberg said, especially considering that a person's genetic makeup is so personal and "might be a more compelling motivator than something like their cholesterol level or a lifestyle choice like smoking."
Dr. Durado Brooks, director of prostate and colorectal cancer with the American Cancer Society, agreed with Weinberg that the finding was surprising.
"The theory around genetic testing is that if you tell people they're at a higher risk of disease XYZ, the hope is that they'll modify their behavior," Brooks said. "This does not support that hope or theory."
Genetic tests have been a hot topic for several years as companies have begun offering them to the public along with insight about people's risks of developing various diseases. One big question remains largely unanswered: What will people do differently, if anything, once they get a glimpse into what their medical futures may hold?
In this latest study, the researchers focused on 783 people aged 50 to 79 who hadn't been screened for colon cancer recently. Of those, 541 of them were told that their genetic tests revealed their risk of colon cancer was doubled (about 1 in 20).
"That's essentially the risk associated for heart disease with an elevated cholesterol level," Weinberg said. "We made it very clear that this was only one risk factor. Whether or not that risk factor was present, everyone should get screened for colon cancer."
Only slightly more than a third of those at high risk got screened within six months, a percentage that was identical to those with average risk.
What's going on? Brooks speculated that the people in the study may be unique because they weren't screened recently. As a result, they may be less likely to get screened in general, he said.
Weinberg said the extra risk in this case may not have been high enough to convince people to act. "It makes you wonder what's going to happen if there's more direct-to-consumer genetic testing," he noted.
The study appears in the Oct. 21 issue of the Annals of Internal Medicine.
More information
For more about colon cancer screening, try the U.S. National Cancer Institute (http://www.cancer.gov/cancertopics/factsheet/detection/colorectal-screening ).
SOURCES: David Weinberg, M.D., chairman, medicine, Fox Chase Cancer Center, Philadelphia, Pa.; Durado Brooks, M.D., M.P.H., director, prostate and colorectal cancer, American Cancer Society, Atlanta, Ga.; Oct. 21, 2014, Annals of Internal Medicine
by E.J. Mundell

Multiple Drug Use Raises Infection Risk for 'Swinging' Couples

Researchers cite need for safe sex practices
FRIDAY, Oct. 24, 2014 (HealthDay News) -- Multiple drug use put couples who "swing" at increased risk for sexually transmitted diseases (STDs), a new study shows.
Swingers are defined as heterosexual couples who have group sex, swap partners and/or visit sex clubs for couples. Researchers looked at 289 people, average age 49, in the Netherlands who said they were swingers and visited an STD clinic between 2009 and 2012.
Half of the participants said they'd had six or more sex partners in the last six months, and had not used a condom during vaginal sex. More than half said they'd had group sex during the same time, and half of them did not use condoms.
One quarter of the men reported having sex with other male swingers in the last six months, according to the study published Oct. 23 in the journal Sexually Transmitted Infections.
Overall, rates of chlamydia and/or gonorrhea were 13 percent, but no other STDs were present among the participants.
The researchers found that 79 percent of the swingers said they used erectile dysfunction drugs and recreational drugs such as cocaine, LSD, methamphetamines, marijuana, laughing gas and alcohol, and that 46 percent reported multiple drug use.
Recreational drug use (other than alcohol and erectile dysfunction drugs) was associated with high-risk sexual behaviors in men and women, while drug use was only independently associated with STDs in female swingers, especially those who took part in group sex.
"Drug-using populations are a target for interventions that address the practice of safer sex along with secondary prevention of drug use," the researchers wrote.
More information
The U.S. Centers for Disease Control and Prevention explains how to prevent sexually transmitted diseases (http://www.cdc.gov/std/prevention/default.htm ).
SOURCE: Sexually Transmitted Infections, news release, Oct. 23, 2014

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